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l• 20FdrOFFICE USEQ'r��' t. t_ w -------------- APPLICATION FOR SANITATION PERMIT Permit No. . .!-_ - - --- ------------------- - ---------------- - ------- (Complete in Duplicate) 7 This Permit Expires 1 Year From Date Issued Date Issued ___-/ $` Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with Count Ordinance No. 549. JOB ADDRESS AND LOCATION - S -- K - �y ---------------------------------------------------------------------••------._... IOwner's Name--- ------ t- - Phone------------------------------------ ' Address----- &112n -------------- {� --------------------------------- -------------------------------•----------------------------•------------ -------------- -- - -------------- Contractor's Nam -1 �� _. --------------------------------------------------------------------- Phone-------------- -------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /----- Number of bedrooms -3---- Number of baths _/_____ Lot size _T�"X..� Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _4 0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe ®—�ardpan ❑ Previous Application Made: (If yes,date--------- --- -7--) No [n New Construction: Yes ❑ No Ej-- FHA/VA: Yes ❑ No [F— TYPE OF INSTALLATION AND SPIECIFICATIONS: j (No septic tank or cesspool permitted if public sewer is available within,200 feet.) Septick. Distance from nearest well-----------------Distance from foundation-------------------Material__..__-_.__-"_.__..___.______.-_ - r No. of compartments--------------------.-----Size---------------•---------------Liquid depth-------------- ----------Capacity-------------- - - Dispo Field- Distance from nearest well....____"--------Distance from foundation--------------------Distance to nearest lot line--------- Number of lines#-•-------------------------------Length of each line_-----------------------------Width of trench-------------------- Type of filter material-------------------------Depth of filter material--------.- -------Total length----------------__--------------------:--- �f[ i I Seepage Pit: Distance to nearest "ell_--_=------------Distance m fou dation-/�__--_._.___Distance to nearest lot line----------------- ®_ Number of pits."t-------------------Lining material - 3 Size: Diameter -..._-Depth -------- --- Cesspool: Distance frorri iearest well-----------_-----Distance from foundation........---- ___.Lining material---________-_---"_..__._ ❑ Size: Diameter--: --------------_---- - ---------Depth-- -- ------------- ---------- ------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------__________________________..___---____-Distance from nearest building 11 r g ❑ Distance to nearest lot {ine----- ----------------- - ----- --- -------------------------------------------- --- ------------------------------------------------ 1110 , Remodeling and/or repairing (describe):--------.----------------------------------------------------------------------------------------------- +1 ---------------------------------------- 1 --------- ----------- --------------- ---------------------- .. ----------------------------------------------- I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, d rules a re lations f the San Joaquin Local Health District. ` (Signed) -------- - (Owner and/or Contractor] --------------- By:-------------------------------•----------- --------------------------------------- ---------------------------------------------(Title---------------------------- -------- -- --------- (Plot plan, showing size of lot, locatiot n of system in relation to wells, buildings, etc., can be placed on reverse side). , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ - -------------- - DATE---- REVIEWED BY - -------- - ------ ------- DATE BUILDING PERMIT ISSUED----------------4--------------------- ---------------------------------------------------------- -- DATE----------------------------- Alteratio s and/or recom en ations:'---------------D "-- - ------------ ------------------------------------------------ ---•-------------------------------- - - --- ---------------- ----------- ------------------- ---------------------------------- ------------------ --------------------------------------- ------------------------- ------------------------------- - --------------- ----------I----------------------- ------------------------------------------------------------------------------------- ....... -------- --- --------------------- FINAL -----------------.--------- ------------------- FINAL INSPECTION BY:----------- n Rate. �� .26 -( SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.